Asian highway threatens to hasten spread of AIDS

July 17, 2004 — 10.00am

A soon-to-open super highway though Asia threatens to become the new transmission route for HIV in the region, following truck drivers and the industries that service them through dozens of countries in a frustrating repetition of the factors that fuelled the African AIDS epidemic.

The Asian Highway Project - a grand plan to link by road countries throughout the region that was first flagged in 1959 - is already under construction, with sections of the road due for completion over the next three years.

A boon for burgeoning and struggling economies in the region, the highway will make the movement of goods and people quicker and easier, covering 31 countries with a road network of 130,000 kilometres.

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But along with truck drivers and tourists, HIV is constantly on the move, and experts are concerned that with improved transport infrastructure will come a rapid increase in HIV transmission. They have criticised countries for not enacting prevention campaigns to keep pace with road construction.

Chris Beyrer, an associate professor in public health at Johns Hopkins University in the US, has studied the transmission of HIV along travel routes in Asia, tracking specific genetic sub-types of the virus along the Silk Road and around the heroin trafficking routes in northern Thailand, Burma, China, Laos and Vietnam.

His studies have shown that HIV follows any traffic route there is - whether the cargo is drugs, people or goods.

"If there is a transport route you need to put comprehensive prevention strategies in place well in advance. With the new Asia Highway it is not a question of if there will be an explosion in HIV, but how quickly it will happen," he told the Herald.

One of the highway's new links will run between Yunnan province in southern China and Chiang Rai province in northern Thailand. Each has the highest HIV rate in its country. Between them is Laos - a country with very low rates of HIV, minimal education and a poor health service.

"It is not just a risk that you will create the prefect environment for an epidemic in Laos, it is a virtual certainty. It would be striking if it didn't happen," Dr Beyrer said.

The UN Development Program is running a migration and vulnerability project for the highway, but there are fears that governments are not taking the threat of an AIDS epidemic seriously. So far only Laos and Cambodia have appointed HIV advisers to their transport ministries.

"The people moving these goods are not Lao, so the Lao national committee on HIV can only do so much. China has to be involved, Thailand has to be involved, and the trucking companies themselves have to be involved," Dr Beyrer said.

Prevention must be more than just posters on the border, he said. Instead of police crackdowns and bribes, there must be sex worker clinics, condom promotion and services to treat sexually transmitted infections.

Another vulnerable country is Bangladesh - again with a relatively low rate of HIV, but soon to be connected by the new highway with Burma, which has one of the highest prevalence rates in the region, he said.

The connection between pandemics and transport is not new, said Lynn Arnold, the vice-president of World Vision in Asia and the Pacific.

"There have been epidemics and pandemics in previous centuries that have gained historical status from their capacity to travel rather than from their actual virulence. The bubonic plague, smallpox, syphilis, measles and the 1918 influenza are just cases in point," said Mr Arnold, a former premier of South Australia.

With the health threats caused by the highway there also comes a "bold new world of open doors" promising great economic benefits for those who live along the transport corridor.

" 'Don't do it' [the highway] is hardly a viable response," Mr Arnold said. "Instead you need to recognise that as the Asia highway project expands you suddenly have a huge increase in the mobility of the HIV epidemic."

He also points to the area known as the "golden quadrilateral" in India, which will be ready in 2005, linking Chennai, Mumbai, Delhi, Kolkata and back to Chennai.

"This huge increase in capacity for goods to be transported around India will be carried out by huge increases in truck drivers, and if left unchecked there will inevitably be huge increases in HIV unless substantial efforts are made in prevention campaigns."

Truck registrations in India and China had already risen substantially in anticipation of the completion of sections of the highway, Mr Arnold said.

The ASEAN part of the highway, through Cambodia, Laos, Vietnam and Southern China, is due for completion in the next three years, with the whole grand plan - from Istanbul to Tokyo - in place by 2015.

The head of UNAIDS, Peter Piot, warned this week that the epicentre of the HIV epidemic is set to move to Asia, where 7.4 million people are already infected. But it is the world's two most populous countries, China and India, with 2.25 billion people between them, that are causing the most alarm. UNAIDS predicts an HIV epidemic of 10 million in China by 2010.

Meanwhile, India has the largest HIV-positive population outside South Africa. Poor disease monitoring systems and government inaction mean the total is likely to be much larger than the reported 4.6 million.